- Cognizant (Denver, CO)
- Provider Appeals & Grievances Specialist ( remote ) This is a remote position open to any qualified applicant that lives in the United States. Summary: ... We are seeking a dedicated Provider Appeals & Grievance Specialist with1 to 2...with CMS Billing and Coding-Medical Insurance Knowledge of Member/Provider Appeals and Grievances , processes, resolutions, compliance TAT… more
- Molina Healthcare (Sterling Heights, MI)
- …month Essential Job Duties Facilitates comprehensive research and resolution of appeals , disputes, grievances , and/or complaints from Molina members, providers, ... ensure that internal and/or regulatory timelines are met. Researches claims appeals and grievances using support systems to determine appropriate appeals and… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Specialist I (Temporary) Job Category: Customer Service Department: CSC Appeals & Grievances ... achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances Specialist I...requires work after hours, on weekends, holidays, a hybrid remote schedule, occasional flexibility in hours/shift in critical situations… more
- LA Care Health Plan (Los Angeles, CA)
- Customer Solution Center Appeals and Grievances Specialist II (Temporary) Job Category: Customer Service Department: CSC Appeals & Grievances ... safety net required to achieve that purpose. Job Summary The Customer Solution Center Appeals and Grievances (A&G) Specialist II will receive, investigate… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Appeals Specialist I is responsible for the initial analysis of appeals and/or grievance correspondence, and ... and tracking information to facilitate and expedite processing of appeals and/or grievances received from a variety...breaching confidentiality of medical information. + Assists Supervisor and Appeals Specialist II and III with unit… more
- Tufts Medicine (Boston, MA)
- …research breakthroughs to life. **Job Overview** The Senior Employee & Labor Relations Specialist serves as a trusted subject matter expert and strategic partner to ... role may delegate and oversee the work of the Employee & Labor Relations Specialist . This position requires deep knowledge of both employment and labor laws (eg,… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …healthcare? Bring your true colors to blue. The Role:The Peer Review Specialist is responsible for monitoring the quality of the credentialed practitioner/ ... Credentialing & Peer Review (CPR) Team, the Peer Review Specialist works closely with CPR's Director and Clinical Lead,...subscriber certificates and apply to the investigation of member grievances . + Manage the fair hearing process for cases… more
- Centene Corporation (Columbus, OH)
- …division of financial responsibility interpretation, contract rate and language interpretation, appeals , grievances and eligibility. + Serve as primary point ... reimbursement, paid time off plus holidays, and a flexible approach to work with remote , hybrid, field or office work schedules. Actual pay will be adjusted based on… more
- Commonwealth Care Alliance (Boston, MA)
- …schedule issues. + Collaborate closely with Provider Relations, Contracting, Payment Integrity, Appeals & Grievances , and Configuration teams to validate and ... 011250 CCA-Claims **_This position is available to remote employees residing in Massachusetts. Applicants residing in other states will not be considered at this… more
- Molina Healthcare (NE)
- …to provide quality and cost-effective member care. This position will be supporting our Appeals and Grievances department. We are seeking a Registered Nurse with ... Review Nurse provides support for medical claim and internal appeals review activities - ensuring alignment with applicable state...Further details to be discussed during our interview process. Remote position with location preference in MI, IL or… more
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